EDI Modernization for Healthcare

EDI Modernization for Healthcare

Do Your EDI Processes Fall Short?

Across all industries, business processes are becoming increasingly digitized, and healthcare is no exception. Electronic data interchange (EDI) applies standards to move data between systems in a structured way. This is especially important when it comes to sensitive data like health claims transactions. Electronic attachments for insurance claims are just one example of EDI at work in healthcare.

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The inclusion of EDI is a top-of-mind need because of the proven increase in efficiency it provides. When supporting electronic documentation is included with a claims submission, it leads to fewer claim denials, reduced reworking, and an increase in ROI. While attachments are a relatively small part of the electronic claims process, they have a substantial impact on the speed of claims resolution.

Compliance with HIPAA regulations and ANSI standards is a key part of any enterprise’s EDI structure. However, businesses may lack real-time information on transaction status and HIPAA compliance, and may spend too much time correcting erroneous EDI transactions. Furthermore, reliance on manual EDI processes can lead to impacted revenue, scalability problems, and regulatory penalties.

The Benefits of the EDI Modernization for Healthcare Solution

  • Streamline operations. Enhances submissions onboarding, processing, and reconciliation, with a single console for claims exception handling.
  • Improve accuracy. Grants deep visibility into transactions and metadata, while enabling automatic review, flagging, and error corrections in a variety of leading formats. Provides a real-time monitoring console and reporting dashboard for more thorough compliance auditing.
  • Transaction completeness and timeliness. Reconciles transactions and offers real-time information on transaction status and HIPAA compliance. Transactions are ingested from multiple sources to ensure all relevant data is included, and supplemental data is used to correct and append to original submissions to support payment and risk adjustment factors.

Realize Business Benefits with a Prolifics Solution

Prolifics’ EDI Modernization for Healthcare solution helps consolidate data across the enterprise, ensuring that is organized, complete, accurate, efficient, and delivered in a timely fashion. With this scalable, cost-efficient solution in place, organizations can confidently manage processes specific to the healthcare EDI sphere, including Medicaid claims, RAPS and EDPS, dual-eligible beneficiaries, and more, all within the same system.


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